Clinical Exam

HISTORY

It is very important to understand a patient’s history prior to performing a clinical exam. In fact, it is generally felt approximately 85% of the time that one can arrive at a working diagnosis for a knee pathology based on the history alone. The physical exam can then be more focused to confirm or supplement this based on the patient examination.

DATE OF INJURY

One of the first things that should be questioned is to determine when the injury occurred. This helps to determine if this is a recent onset, acute injury, or a chronic injury. In some instances, it may be an acute injury with a previous chronic problem.

MECHANISM OF INJURY

The mechanism of injury, or “how”, is also very important to determine for each patient. It helps to distinguish between whether there was a contact or non-contact mechanism, whether the patient had a twisting or giving-way episode or other means of injury.

LOCATION OF INJURY

It is also very important to determine the “where” for an injury. Did this occur at a sporting event, work, or during recreational activities? This also helps to hone down the questions to be asked including weather conditions, shoe wear, uneven terrain or other factors which may have lead to the injury.

PREVIOUS INJURIES OR SURGERIES

It is not that uncommon for patients to present with an acute exacerbation of a previous chronic injury, and sometimes the patient does not remember the previous injury. Thus, it is important to determine if they did have a previous injury or if this is a new onset injury. This is important because it could affect their ultimate treatment recommendations.

In addition, it is important to know a patient’s previous surgeries, the type of surgery performed and the patient’s response to their symptoms before and after surgery. It also very helpful for the patient to bring all medical records including operative notes and operative photographs the day of their clinic visit to help supplement their understandings of what happened during surgery.

FUNCTIONAL LIMITATIONS

It is very important to determine a patient’s actual limitations due to an injury. For example, do they have problems with giving way, going up or down stairs, going up or down inclines, twisting, turning or pivoting? It is also helps to determine if they have difficulty with squatting, arising from a chair, or other activities.

In addition, it is important to try and determine what the patient’s desires are for increasing their activity level. This can vary greatly based on the age of the patient, sporting activities, recreation activities, work, and their overall expectations. While some patients may wish to desire to get back to functioning like their knee once was, in some instances with significant scar tissue or arthritis (for example), these may be unrealistic expectations and it is important to review this with the patient early on so they can work to get to their highest level of post-injury functioning.

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Robert LaPrade, MD, PhD has specialized skills and expertise in diagnosing and treating complicated knee injuries. He has treated athletes at all levels, including Olympic, professional and intercollegiate athletes, and has returned numerous athletes back to full participation after surgeries. Recognized globally for his outstanding and efficient surgical skills and dedication to sports medicine, he has received many research awards, including the OREF Clinic Research Award considered by many a Nobel Prize in orthopedics. Dr. LaPrade is one of the most published investigators in his field, and many of the surgeries that he has developed are now performed worldwide and recognized as the “gold standard” for the treatment of complex knee injuries.

I struggled with my knee for 18 months - having gone from 10,000 steps a day to only walking as needed. Previous attempts to make it better provided only temporary relief. (including injections and arthroscopic surgery), I heard Dr. La Prade was going to practice in the Twin Cities - where I live, & waited for him, based on his renown reputation. I am so glad I did! Dr LaPrade performed a deep root repair to my meniscus, which saved me from a knee replacement at this time. I am 5-months post surgery, and am doing great, stationary biking and exercising every day, no pain.You know you are seeing the best when you find out he has written over 500 medical journal articles - among many other accomplishments. Hey - if he is good enough for Olympic and professional athletes…..he's good enough for me! Thank you, Dr. LaPrade, for treating me with the care, focus, and expertise as if I was an Olympic athlete!- From your 63 year old very appreciative patent ~

Dr. Robert F. LaPrade operated on my right knee in May of 2010. I was hit by a car on my bicycle near Horsetooth Reservoir in CO. I was life flighted to MCR in Loveland, CO. My orthopedic injuries were severe, but totally missesd by the orthopedic team at Poudre. I could not bear weight on my right side though I tried repeatedly, but finally I went and got an MRI and one of the orthopedic surgeons that I worked with was shocked when he saw the MRI result. My right knee was totally destroyed; ACL, MCL, PCL all severely torn; the patella was the only thing intact in my right knee. Dr. La Prade had just moved to Vail and I was his 2nd patient @ The Steadman Clinic. I was told by one of the orthopedic surgeons that I worked with that I would never run again and would be lucky if I could ever hike again. This was devastating news after being a top triathlete (3rd in the world in my age group in 1989 & 1st nationally in my age group) and a big marathon runner. All I can say is Dr. La Prade did an amazing job and I am not limited in any of my activites. I can run, bike, & climb mountains. In fact 2 years ago I finished climbing the top 100 peaks in CO.

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I struggled with my knee for 18 months - having gone from 10,000 steps a day to only walking as needed. Previous attempts to make it better provided only temporary relief. (including injections and arthroscopic surgery), I heard Dr. La Prade was going to practice in the Twin Cities - where I live, & waited for him, based on his renown reputation. I am so glad I did! Dr LaPrade performed a deep root repair to my meniscus, which saved me from a knee replacement at this time. I am 5-months post surgery, and am doing great, stationary biking and exercising every day, no pain.You know you are seeing the best when you find out he has written over 500 medical journal articles - among many other accomplishments. Hey - if he is good enough for Olympic and professional athletes…..he's good enough for me! Thank you, Dr. LaPrade, for treating me with the care, focus, and expertise as if I was an Olympic athlete!- From your 63 year old very appreciative patent ~

"Dr Laprade operated me after my father took me to the Steadman Clinic, and having been operated once before in MX, he rebuilt my knee and made me fully functional since then. A very human Physician, and incredible care." - Galia S.

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